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<body>
	<h3>CONTRACTOR CHECKLIST – TAX AND WORKERS COMPENSATION </h3>
 
<table class="table1" >
	
	<tr>
		<th>
			1 FORM HANDLING INSTRUCTIONS 
		</th>

	</tr>

	<tr>
		<td>
		All fields are mandatory, unless otherwise indicated.
	    Attach the completed form to respective Vendor Setup forms Incomplete forms will be returned. 
 	


		</td>


	</tr>


</table>

<table class="table2" >
	
	<tr >
		<th colspan="6">
			CONTRACTOR PROFILE 
		</th>

	</tr>

	<tr>
		<td >
		Person Name:
 	
		</td>
		<td colspan="5">
		
 	
		</td>
		


	</tr>

    <tr>
		<td >
		 Person’s representative name 
 	
		</td>
		<td colspan="3">
		
		</td >
		<td colspan="2">
			
			ABN: 
		</td>
		


	</tr>
	<tr>



			<td >
		 Downer Approved Contract Signed:
 	
		</td>
		<td>
			Y / N 
		
		</td >
		<td >
			
			Date: 
		</td>
		<td width="60px">
			
			 
		</td>
		<td >
			
			Engaged as (Comp, Trust or Partnership): 
		</td>
		<td width="200px">
			
			
		</td>





	</tr>


	<tr>



			<td >
		 W/comp certificate of currency provided 
 	
		</td>
		<td>
			Y / N 
		
		</td >
		<td >
			
			Date: 
		</td>
		<td >
			
			 
		</td>
		<td >
			
			No. of employees delivering services:
		</td>
		<td >
			
			
		</td>





	</tr>

	 <tr>
		<td >
		Work Type:
 	
		</td>
		<td colspan="3">
		
		</td >
		<td colspan="2">
			
			Business Unit: 
		</td>
		


	</tr>
	<tr>
		<td >
		State in which the work is to be performed: 
 	
		</td>
		<td colspan="5">
		<form>
            QLD
            <input type="radio"  name="State" value="QLD" />

            NSW
            <input type="radio" name="State" value="NSW" />
            VIC 
            <input type="radio" name="State" value="VIC" />
            SA 
            <input type="radio" name="State" value="SA" />
            WA 
            <input type="radio" name="State" value="WA" />
            NT 
            <input type="radio" name="State" value="NT" />
            TAS  
            <input type="radio" name="State" value="TAS" />
            ACT  
            <input type="radio" name="State" value="ACT" />


         </form>
		</td >
		</tr>


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<div>

<h3>
	INSTRUCTIONS 


</h3>

<p>This checklist is to be read in conjunction with Downer’s Contractor Engagement Procedures and Guide (DG-FN-PR-203 and DG-FN-GU-203). If the Person to be engaged is not a company, trust or partnership, this checklist does not apply. Please consult HR/Recruitment to discuss employment engagement or using a labour hire firm. Please remember that <strong>Contractors must not be treated like a Downer employee.</strong> Please also ensure that engagement contract does not result in an employment agency contract. Refer to the Guide for further details. </p>
<p>All Tests to be applied as per Contractor Engagement Procedure – Tax and Workers Compensation document. </p>
</div>
<br>
<br>
<br>
<br>


<table class="table3" >
	
<tr>
		<th colspan="2">
			TEST 1 – PAYROLL TAX EXEMPTION 
		</th>

		<th>
			YES
		</th>

		<th>
			NO 
		</th>

	</tr>

	<tr>
		<td>
			1
		</td>
		<td>
		Contractors engage additional labour to fulfil the services under contract.  Labour engaged to fulfil non-contracted services such as administrative roles are ignored for this exemption. 
  . 
 	
		</td>
		
		<td>
			 <input type="radio"  name="111" value="111" />

		</td>
		<td>
			 <input type="radio"  name="111" value="111" />

		</td>


	</tr>

	<tr>
		<td>
			2
		</td>
		<td>
		The Contractor is engaged for 90 days or less in total under all contracts in any one financial year. 
 	
		</td>
		
		<td>
			 <input type="radio"  name="222" value="222" />

		</td>
		<td>
			 <input type="radio"  name="222" value="222" />

		</td>


	</tr>

<tr>
		<td>
			3
		</td>
		<td>
		<p>(i) The services are not normally required by Downer; and </p>
		<p>(ii) The Contractor provides such services to the general public. </p>

		</td>
		
		<td>
			 <input type="radio"  name="333" value="333" />

		</td>
		<td>
			 <input type="radio"  name="333" value="333" />

		</td>


	</tr>
	<tr>
		<td>
			4
		</td>
		<td>
		Services covered by the contract are normally required (either by this Contractor or any other contractor) for less than 180 days in total in the financial year e.g. they are used only on weekend only or seasonal work. 
 	
		</td>
		
		<td>
			 <input type="radio"  name="444" value="444" />

		</td>
		<td>
			 <input type="radio"  name="444" value="444" />

		</td>


	</tr>
	<tr>
		<td>
			5
		</td>
		<td>
		The contract is exclusively for the conveyance or delivery of physical goods and the Contractor conveys goods in a vehicle they provide. 
		</td>
		
		<td>
			 <input type="radio"  name="555" value="555" />

		</td>
		<td>
			 <input type="radio" name="555" value="555" />

		</td>


	</tr>
<tr>
		<td>
			6
		</td>
		<td>
		The contract is one under which the supply of labour is ancillary to the supply or use of goods owned by the Contractor, i.e. the supply of goods is more than 50% of the total contract amount. 
		</td>
		
		<td>
			 <input type="radio"  name="666" value="666" />

		</td>
		<td>
			 <input type="radio"  name="666" value="666" />

		</td>


	</tr>

</table>

<br><br>

	<table class="table4">
	
<tr>
		<th colspan="2">
			TEST 2 - WORKERS COMPENSATION POLICY
		</th>

		<th>
			YES
		</th>

		<th>
			NO 
		</th>

	</tr>

	<tr>
		<td>
			1
		</td>
		<td>
		Does the contractor carries its own workers compensation insurance and has an associated Certificate of Currency been provided? 
  . 
 	
		</td>
		
		<td>
			 <input type="radio"  name="1111" value="1111" />

		</td>
		<td>
			 <input type="radio" name="1111" value="1111" />

             Do not engage- test stops here 

		</td>


	</tr>

	<tr>
		<td>
			2
		</td>
		<td>
		Is the contractor being engaged in WA, NT, TAS or NSW?  
		</td>
		
		<td>
			 <input type="radio"  name="2222" value="2222" />
			 Continue to Q3 

		</td>
		<td>
			 <input type="radio"  name="2222" value="2222" />
 
             Include in W/Comp 

		</td>


	</tr>

<tr>
		<td>
			3
		</td>
		<td>
		If engaging in WA, NT or TAS, has a policy endorsement also been provided? Or, if engaging in NSW, has a Subcontractor Statement been provided? 
 
		</td>
		
		<td>
			 <input type="radio"  name="3333" value="3333" />
			 Exempt from W/Comp 

		</td>
		<td>
			 <input type="radio"  name="3333" value="3333" />
			 Include in W/Comp 

		</td>


	</tr>



</table>


<br><br>

	<table class="table5">
	
<tr>
		<th colspan="2">
			DECLARATION
		</th>

		

	</tr>

	<tr>
		<td>
			<p>I hereby declare that the responses above are a true reflection of the intended contractual nature of the engagement with Downer. I acknowledge that this declaration governs the liability for taxes and levies. I acknowledge that Downer is entitled to deduct the amount of taxes and levies from its payments should the contractual nature of the engagement be changed. </p> 
			<p>Person representative’s name: </p>
			<p>Person representative’s signature </p>
			<p>Date: </p>
		</td>
		<td>
			<p>I hereby declare that the responses above are a true reflection of the intended contractual nature of the engagement with Downer. I acknowledge that this declaration governs the liability for taxes and levies. I acknowledge that Downer is entitled to deduct the amount of taxes and levies from its payments should the contractual nature of the engagement be changed. </p> 
			<p>Downer Hiring manager:  </p>
			<p>Manager signature:  </p>
			<p>Engaging entity name (e.g. Downer EDI, Downer Engineering Power etc.: </p>
			<p>Date: </p>
 	
		</td>
		
		

	</tr>

	


</table>

<br>
<br>

 <div class="table66">

<strong style="margin: 20px">OFFICE USE ONLY – DATA MAINTENANCE – CROSS OUT WHERE NOT APPLICABL</strong>
<br><br>
<table class="table6" >
	
<tr>
		<th >
			TEST
		</th>

		<th>
			RESULTS
		</th>

		<th>
			YES
		</th>
		<th>
			NO
		</th>

	</tr>

	<tr>
		<td>
			1
		</td>
		<td>
		Was there at least one question under Test 1 respondent to as Yes? 
  . 
 	
		</td>
		
		<td>
			
         Exempt from payroll tax. Proceed to Test 2. 
		</td>
		<td>
			 Subject to payroll tax.  Proceed to Test 2. 

		</td>


	</tr>

	<tr>
		<td>
			2
		</td>
		<td>
		The Contractor is engaged for 90 days or less in total under all contracts in any one financial year. 
 	
		</td>
		
		<td>
			 What is result of Test 2? 

		</td>
		<td>
			 <p><input type="radio"  name="111111" value="11111" /> Do not engage </p>
			  <p><input type="radio"  name="111111" value="22222" /> Exempt from w/comp </p>
			  <p> <input type="radio"  name="111111" value="33333" />Include in w/comp </p>

		</td>


	</tr>



</table>


<p><strong>Record results belo</strong></p>
<P>
	As Contractor, subject to:
	<input type="radio"  name="1111111" value="111111" />Payroll tax 
	<input type="radio"  name="1111111" value="222222" /> Workers compensation  
</P>
<br><br>


<p><strong>
 Forward form to Accounts Payable as part of vendor setup and to Workers Compensation and Injury Management team If Payroll tax box is ticked, also forward a copy of the form to Payroll and Tax function </strong></p>
 <br>
 <p>Name: (print)_______________          Signature________________</p>


 <br>
 Date:___________________ 


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